Social cultural and environmental contexts and the measurement of burden of disease: An exploratory study in the developed and developing world

The Disability Adjusted Life Year (DALY) is a measure of population health that was developed, as part of a World Bank initiated study, to inform health strategy development, priority setting, resource allocation and research, and to measure the global burden of disease. The innovative feature of the DALY was the combination of information on morbidity and mortality within a single index. Since its development in 1992, the rate at which it has been adopted by governments, multilateral agencies and researchers has been staggering. The enthusiasm with which the measure has been taken-up perhaps reflects a desire on the part of health policy makers to embrace an “evidence-based” approach to health policy. Although the DALY has been heavily criticised in some quarters, it has survived.This report details the findings of an empirical investigation of some of the technical and social assumptions on which the DALY is based. The specific aim was to examine the justification behind the use of a single global severity weight for each health condition without regard to contextual factors. The objectives of the study were to examine the notion that the burden of a disease is broadly similar without regard to country, environment, gender or socioeconomic status, and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors.